Allograft pancreatic duct dilatation following bladder drained simulataneous pancreas-kidney transplantation: Clinical significance

Gaetano Ciancio, Berta Montalvo, David Roth, Joshua Miller, George W Burke

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5 Citations (Scopus)

Abstract

Objective. Radiologic imaging of the allograft pancreatic duct dilatation is an uncommon multifactorial finding that is not well described. The purpose of this investigation is to determine the clinical correlation of this finding. Design. Retrospective study. Setting. University Hospital, USA. Subjects. One hundred forty five simultaneous pancreas-kidney transplants have been performed for treatment of type I diabetes mellitus and end-stage renal disease between February 1993 and December 1999 at the University of Miami. Main outcome measures. In 5 recipients, the pancreatic duct was noted to be dilated by ultrasound 1-18 months post-transplant. Results. In all 5 recipients a Foley catheter was placed as the first line of treatment. This reduced the size of the pancreatic duct in one patient, who presented with normal serum amylase and lipase and hyperglycemia. A pancreas biopsy done with Foley catheter in place showed fibrosis with no evidence of rejection. Four patients with dilated pancreatic duct presented with increased serum amylase and lipase; however improvement of the pancreatic duct dilatation was seen only after anti-rejection therapy. One of the patients developed recurrence of pancreatic duct dilatation and a video-urodynamic study subsequently demonstrated voiding with abdominal straining and no detrusor activity. He ultimately underwent enteric conversion with resolution of pancreatic duct dilatation. Conclusions. This infrequent complication of dilated transplant pancreatic duct could be multifactorial. It could suggest the diagnosis of reflux pancreatitis, which should resolve with bladder decompression. In fact, 1 patient presented with reflux pancreatitis caused by external sphincter detrusor pseudodyssynergia. However, this ultrasound finding may also be associated with pancreas rejection (4/5 patients).

Original languageEnglish
Pages (from-to)4-12
Number of pages9
JournalJournal of the Pancreas
Volume1
Issue number1
StatePublished - May 1 2000

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Pancreas Transplantation
Pancreatic Ducts
Kidney Transplantation
Allografts
Dilatation
Urinary Bladder
Pancreas
Amylases
Lipase
Transplants
Pancreatitis
Catheters
Urodynamics
Decompression
Serum
Type 1 Diabetes Mellitus
Hyperglycemia
Immunosuppression
Chronic Kidney Failure
Fibrosis

Keywords

  • Dilatation
  • Kidney transplantation
  • Pancreas transplantation
  • Pancreatic ducts

ASJC Scopus subject areas

  • Endocrinology
  • Gastroenterology

Cite this

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title = "Allograft pancreatic duct dilatation following bladder drained simulataneous pancreas-kidney transplantation: Clinical significance",
abstract = "Objective. Radiologic imaging of the allograft pancreatic duct dilatation is an uncommon multifactorial finding that is not well described. The purpose of this investigation is to determine the clinical correlation of this finding. Design. Retrospective study. Setting. University Hospital, USA. Subjects. One hundred forty five simultaneous pancreas-kidney transplants have been performed for treatment of type I diabetes mellitus and end-stage renal disease between February 1993 and December 1999 at the University of Miami. Main outcome measures. In 5 recipients, the pancreatic duct was noted to be dilated by ultrasound 1-18 months post-transplant. Results. In all 5 recipients a Foley catheter was placed as the first line of treatment. This reduced the size of the pancreatic duct in one patient, who presented with normal serum amylase and lipase and hyperglycemia. A pancreas biopsy done with Foley catheter in place showed fibrosis with no evidence of rejection. Four patients with dilated pancreatic duct presented with increased serum amylase and lipase; however improvement of the pancreatic duct dilatation was seen only after anti-rejection therapy. One of the patients developed recurrence of pancreatic duct dilatation and a video-urodynamic study subsequently demonstrated voiding with abdominal straining and no detrusor activity. He ultimately underwent enteric conversion with resolution of pancreatic duct dilatation. Conclusions. This infrequent complication of dilated transplant pancreatic duct could be multifactorial. It could suggest the diagnosis of reflux pancreatitis, which should resolve with bladder decompression. In fact, 1 patient presented with reflux pancreatitis caused by external sphincter detrusor pseudodyssynergia. However, this ultrasound finding may also be associated with pancreas rejection (4/5 patients).",
keywords = "Dilatation, Kidney transplantation, Pancreas transplantation, Pancreatic ducts",
author = "Gaetano Ciancio and Berta Montalvo and David Roth and Joshua Miller and Burke, {George W}",
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T1 - Allograft pancreatic duct dilatation following bladder drained simulataneous pancreas-kidney transplantation

T2 - Clinical significance

AU - Ciancio, Gaetano

AU - Montalvo, Berta

AU - Roth, David

AU - Miller, Joshua

AU - Burke, George W

PY - 2000/5/1

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N2 - Objective. Radiologic imaging of the allograft pancreatic duct dilatation is an uncommon multifactorial finding that is not well described. The purpose of this investigation is to determine the clinical correlation of this finding. Design. Retrospective study. Setting. University Hospital, USA. Subjects. One hundred forty five simultaneous pancreas-kidney transplants have been performed for treatment of type I diabetes mellitus and end-stage renal disease between February 1993 and December 1999 at the University of Miami. Main outcome measures. In 5 recipients, the pancreatic duct was noted to be dilated by ultrasound 1-18 months post-transplant. Results. In all 5 recipients a Foley catheter was placed as the first line of treatment. This reduced the size of the pancreatic duct in one patient, who presented with normal serum amylase and lipase and hyperglycemia. A pancreas biopsy done with Foley catheter in place showed fibrosis with no evidence of rejection. Four patients with dilated pancreatic duct presented with increased serum amylase and lipase; however improvement of the pancreatic duct dilatation was seen only after anti-rejection therapy. One of the patients developed recurrence of pancreatic duct dilatation and a video-urodynamic study subsequently demonstrated voiding with abdominal straining and no detrusor activity. He ultimately underwent enteric conversion with resolution of pancreatic duct dilatation. Conclusions. This infrequent complication of dilated transplant pancreatic duct could be multifactorial. It could suggest the diagnosis of reflux pancreatitis, which should resolve with bladder decompression. In fact, 1 patient presented with reflux pancreatitis caused by external sphincter detrusor pseudodyssynergia. However, this ultrasound finding may also be associated with pancreas rejection (4/5 patients).

AB - Objective. Radiologic imaging of the allograft pancreatic duct dilatation is an uncommon multifactorial finding that is not well described. The purpose of this investigation is to determine the clinical correlation of this finding. Design. Retrospective study. Setting. University Hospital, USA. Subjects. One hundred forty five simultaneous pancreas-kidney transplants have been performed for treatment of type I diabetes mellitus and end-stage renal disease between February 1993 and December 1999 at the University of Miami. Main outcome measures. In 5 recipients, the pancreatic duct was noted to be dilated by ultrasound 1-18 months post-transplant. Results. In all 5 recipients a Foley catheter was placed as the first line of treatment. This reduced the size of the pancreatic duct in one patient, who presented with normal serum amylase and lipase and hyperglycemia. A pancreas biopsy done with Foley catheter in place showed fibrosis with no evidence of rejection. Four patients with dilated pancreatic duct presented with increased serum amylase and lipase; however improvement of the pancreatic duct dilatation was seen only after anti-rejection therapy. One of the patients developed recurrence of pancreatic duct dilatation and a video-urodynamic study subsequently demonstrated voiding with abdominal straining and no detrusor activity. He ultimately underwent enteric conversion with resolution of pancreatic duct dilatation. Conclusions. This infrequent complication of dilated transplant pancreatic duct could be multifactorial. It could suggest the diagnosis of reflux pancreatitis, which should resolve with bladder decompression. In fact, 1 patient presented with reflux pancreatitis caused by external sphincter detrusor pseudodyssynergia. However, this ultrasound finding may also be associated with pancreas rejection (4/5 patients).

KW - Dilatation

KW - Kidney transplantation

KW - Pancreas transplantation

KW - Pancreatic ducts

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